This one has been around for awhile. I always find it interesting that the most quoted videos and presentations are ones done by non surgeons or pathologists, ie anethesiologists, emergency medicine docs or dentists, none of whom see the injuries from the perspective of the surgeon or pathologist during autopsy.

Brush Okie

04-28-2014, 19:12

This one has been around for awhile. I always find it interesting that the most quoted videos and presentations are ones done by non surgeons or pathologists, ie anethesiologists, emergency medicine docs or dentists, none of whom see the injuries from the perspective of the surgeon or pathologist during autopsy.

What was good and bad about the lecture? Does your experience jive with what he says or are treatments different than how you do it? What is your idea on fluid resuscitation? What BP do you like to maintain?

RichL025

04-29-2014, 11:32

Can't view the video from work (govt computer), but what does an anesthesiologist know about treating bullet wounds?

You will not find _me_ opining about chronic pain or the merits of specific sedation drugs....

Doczilla

09-29-2014, 11:32

This one has been around for awhile. I always find it interesting that the most quoted videos and presentations are ones done by non surgeons or pathologists, ie anethesiologists, emergency medicine docs or dentists, none of whom see the injuries from the perspective of the surgeon or pathologist during autopsy.

The EM docs tend to be pretty active with outreach education to EMS, so it is no wonder that they crop up frequently. Some of that is due to better schedule availability, and some due to their role as EMS medical directors. Prehospital care of trauma victims is often fraught with misinformation and mishandling. Surgeons are far less frequently engaged with this area as medical directors when compared to their EM counterparts. That's not to say that they are not, since we have a couple of surgeons in this area who are very engaged and frequently lecture on the topic. But there is far more teaching to EMS done by EM physicians.

First patient contact of a trauma patient is rarely a surgeon. While prompt surgical care is essential to fixing the problem, the resuscitation will initially be performed by others. Outside of densely populated urban centers most trauma patients will not initially present to a trauma center. Even at trauma centers, the initial receiving physician is often the EM doc. The best surgeon on earth can't do much when a corpse is brought to the OR. The surgical anatomy of the wound is rarely helpful in the management of non compressible hemorrhage by non-surgeons. To ensure that the patient survives the trip to the OR, we need to address the other issues that will contribute to mortality, such as coagulopathy, acidosis, hypoxia, anemia, and hypocalcemia. Management of these problems is not only complementary to the surgical care, but important to the surgeon's success. These are the issues that the EM physician and anesthesiologist are well acquainted with.

'zilla

RichL025

09-29-2014, 19:53

...

... While prompt surgical care is essential to fixing the problem, the resuscitation will initially be performed by others. Outside of densely populated urban centers most trauma patients will not initially present to a trauma center. Even at trauma centers, the initial receiving physician is often the EM doc....

In no level 1 trauma center I have EVER seen or heard of is this true. If the patient is a serious trauma patient, at the very least he is jointly managed by EM and surgery.

The best surgeon on earth can't do much when a corpse is brought to the OR. ... To ensure that the patient survives the trip to the OR, we need to address the other issues that will contribute to mortality, such as coagulopathy, acidosis, hypoxia, anemia, and hypocalcemia. Management of these problems is not only complementary to the surgical care, but important to the surgeon's success. These are the issues that the EM physician and anesthesiologist are well acquainted with.

'zilla

Sorry, but this is a very simplistic view of what a surgeon does. He (or she) is NOT simply an anatomist who fixes a structural problem. The physiology of resuscitation is an intergral part of every general surgeon's training.

Who did the initial research about acidosis, coagulopathy and hypothermia? Hint: it wasn't anesthesiologists. Who is the proponent agency for ATLS?

I have great respect for my EM and Anesthesiology colleagues, but the RESUSCITATION of the sick trauma patient in a trauma center belongs to the surgeons (at least in the US, I have been told it is somewhat different in Europe)

The resuscitation is not a process that ends when the patient leaves the trauma bay, or when he leaves the OR. The EM physician and the anesthesiologist do not follow the patient when he leaves those areas. The surgeon does.

Brush Okie

09-29-2014, 20:18

I am glad to see some feedback from MD's here. I learn a lot from you folks.

As an aside no one is ever perfect. I once had a GSW pt that took a load of bird shot to the chest. He weighed about 300 lbs and while the ER doc and surgeon was looking at the xrays. (only one pellet made it past the rib cage the rest were superficial) they called it buck shot and had a few other errors in their assessment due to lack of knowledge of firearms. They were both good MD's but very little to no knowledge about firearms.

Anyway my point is to try to discuss this type of thing so we all an learn from it since everyone has a different viewpoint of any pt.

Doczilla

10-01-2014, 00:43

Rich, I don't mean to diminish the outstanding work of my surgical colleagues, nor suggest that anyone but the surgeon is the SME in trauma management. As I said, prompt surgical management is the key to patient survival. I'm simply saying that there are others who are essential to the care of these patients and who teach on this subject that have the knowledge and experience to do so.